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IC > Treatment of Hypertension > Flashcards

Treatment of Hypertension Flashcards

1
Q

risk of end organ damage lowest at what BP?

A

115/75

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2
Q

Risk of end organ damages with every of increment of what mm Hg?

A

20/10

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3
Q

increase of systolic BP with age reflects progressive _________ of arterial circulation

A

stiffening

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4
Q

BP reading of systolic 130-139 and diastolic 80-89 indicates what stage of hypertension?

A

stage 1, assess 10 yr risk, if >10% risk give BP med

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5
Q

BP reading of systolic >140 and diastolic >90 indicates what stage of HTN?

A

stage 2, give 2 BP lowering meds of different classes

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6
Q

black patients usually respond well to treatment with _______ and _______, but have smaller BP reductions with ACE inhibitors/ARBs/and Beta blockers

A

calcium channel blockers, diuretics

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7
Q

progression of hypertension with age - cardiac output _______ and TPR ________

A

decreases

increases

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8
Q

drugs that deplete the body of sodium and reduce blood volume

A

diuretics

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9
Q

reduce peripheral vascular resistance

A

agents that interacts with angiotensin

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10
Q

relax vascular smooth muscle and dilate resistance vessels

A

direct vasodilators

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11
Q

reduce peripheral vascular resistance, inhibit cardiac function, increase venous pooling

A

sympatholytic agents

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12
Q
  • thiazide diuretics inhibit _____ reabsorption in DCT

- use at low dose to lower ______ and high dose second to loop diuretics in _______

A

NaCl

BP, CHF

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13
Q

________ is the preferred thiazide diuretic bc of long half life and proven trial reduction of CVD

A

chlorthalidone

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14
Q

thiazide diuretics are most effective in what patient populations?

A

african americans and elderly

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15
Q

this drug class clinically used for:

  • HTN, low dose
  • CHF, higher dose
  • nephrolithiasis: due to idiopathic hypercalciuria to reduce urine calcium concentration
  • nephroenic diabetes insipidus: to reduce polyuria and polydipsia
A

thiazide diuretics

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16
Q

adverse effects of this drug are:

  • hypokalemic metabolic alkalosis
  • hyponatremia
  • hyperGLUC: glycemia, lipidemia, uricemia, calcemia
  • erectile dysfunction, sulfa allergy
A

thiazide diuretics

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17
Q

the only ACE inhibitor that’s an active drug?

A

captopril

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18
Q

ACE inhibitors work by inhibiting conversion of ang-1 to ang-2, which decreases _________, also increased ______ levels

A

peripheral vascular resistance

bradykinin

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19
Q

ACE inhibitors do not cause ________ because of concurrent baroreceptor resetting or vagal activation

A

reflex tachycardia

20
Q

ACE inhibitors are most effective in what population?

A

young and middle aged Caucasians

21
Q
  • side effects of this drug include:
  • dry, hacking, nonproductive cough
  • hyperkalemia due to inhibited aldosterone
  • angioedema and anaphylaxis
  • acute renal failure
  • do not use in combo with ARBs or direct renin inhibitor
  • contraindicated in pregnancy
A

ACE inhibitors

22
Q
  • sartans
  • more specific than ACE inhibitors, do not affect bradykinin metabolism
  • more complete inhibition of angiotensin action
A

angiotensin receptor antagonists (ARBs)

23
Q

-verapamil, diltiazem, amlodipine, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine

A

calcium channel blockers

24
Q

calcium channel blockers work by reducing intracellular calcium, _____ arteriolar smooth muscles, leading to _______ and lower BP

A

relax

vasodilation

25
Q

calcium channel blockers most effective in what population?

A

elderly and african americans (similar to thiazide effectiveness)

26
Q

CCBs:

  • _______ are the strongest vasodilators, but are most likely to produce reflex tachy
  • _______ has the strongest cardiac effects, and don’t cause reflex tachy b/c they depress SA and AV node conduction
A

dihydropyridines (nifedipine)

verapamil

27
Q

____ and ____ are CCBs that are contrainidicated in patients with SA or AV noe abnormalities b/c they cause bradycardia

A

verapamil, diltiazem

28
Q

atenolol, betaxolol, bisoprolol, and metoprolol are _______ beta blockers

A

cardioselective

29
Q

nebivolol is a cardioselective and _______ beta blocker

A

vasodilatory (NO production)

30
Q

nadolol and propanolol and ________ beta blockers

A

non-cardioselective

31
Q

acebutolol, penbutolol, pindolol, and carteolol are beta blockers with _________ activity

A

intrinsic sympathomimetic

32
Q

carvedilol and labetolol are beta blockers with __________ activity

A

alpha and beta receptor (a1 antagonists)

33
Q

beta blockers are most effective in which population?

A

caucasians, young hypertensives

34
Q

beta blockers are combined with other antihypertensives to counteract:

  • ______ caused by vasodilators
  • _________ caused by thiazide and loop diuretics
A

reflex tachy

increased renin secretion

35
Q
  • beta blockers delay recovery of normoglycemia b/c it inhibits hyperglycemic responses mediated by ______
  • significant risk of new onst diabetes
  • abrupt cessation can lead to tachycardia, angina, MI
A

epinephrine

36
Q
  • renin inhibitor
  • orally active
  • dose dependent reduction of plasma renin and BP
  • avoid in pregnancy
A

aliskiren

37
Q
  • blocks renin secretion

- reduction in renal sympathetic nerve activity

A

clonidine

38
Q
  • zosins
  • reduce norepi induced vasoconstriction to dilate both arteries and veins
  • BP falls b/c of decreased peripheral vascular resistance
  • second line for BPH
  • adverse hypotension, dizziniess, palpitations
A

alpha antagonists

39
Q

clonidine, methyldopa, and guanfacine are _________ drugs

  • act on alpha-2 receptors, reduce peripheral vascular resistance
  • sedation and dry mouth, sudden withdrawal leads to hypertensice crissi
  • methyldopa limited to pregnancy
A

centrally acting sympatholytics

40
Q

-oral vasodilators for chronic antihypertensive treatment

A

hydralazine or minoxidil

41
Q
  • sodium nitroprusside
  • diazoxide
  • fenoldopam
  • enalprilat
  • nicardipine
  • hydralazine
  • act on smooth muscle to cause relaxation and reduced vascular resistance
A

IV vasodilators

42
Q

hydralazine, monoxidil, and diazoxidde dilate _______ selectively

A

arteries

43
Q

_______ is a balanced vasodilator of both arteries and veins

A

sodium nitroprusside

44
Q

adverse effects of this drug:

  • reflex tachy
  • increased mycocardial contractions
  • increased renin secretion
  • fluid retention
  • headaches
  • flushing, palpitations
A

vasodilators

45
Q
  • the vasodilator _______ may cause a lupus like syndrome

- _______ causes hypertrichosis (rogaine)

A

hydralazine

minoxidil

46
Q

in pregnant women, use a _______ or _______, methyldopa and hydralazine may also be used

A

beta blocker (labetolol)

CCB (nifedipine)

IC (29 decks)

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